Atypical mycobacterial spondylitis as a challenging differential diagnosis to metastatic disease of the spine: a case report

Wang, Chien Shun; Shang, Feng; Huang, Ling; Yu, Jung Kuang; Chang, Ming Chau; Wang, Shih Tien; Liu, Chien Lin

doi:10.1007/s00590-012-1068-y

Cited by 5 publications

(2 citation statements)

References 23 publications

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“…Drug chemotherapy + Surgery Better Pirofsky et al 45 79/M Back pain T7-T9, T11, L4 Drug chemotherapy Worse Wang et al 46 68/M Back pain T12-L4, S1 Drug chemotherapy Better Uno et al 47 22/M Back pain, Sensory and motor deficit C3, T5, T11 Drug chemotherapy + Surgery Better Giri et al 48 63/M Back pain, Paraplegia C6, T3, T8 Drug chemotherapy + Surgery Better Daripa et al 49 76/M Abdominal pain C7, T11 Drug chemotherapy Better Thawani et al 50 19 53 13/M Back pain C2-C5, C7-T2, T5, T8, T9, T11, L1-S3…”

Section: Laboratory Examinationmentioning

confidence: 99%

Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions

Lyu

Zhang

2023

Orthopaedic Surgery

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Spinal tuberculosis, also known as Pott's disease or tuberculous spondylitis, is usually secondary to primary infection in the lungs or other systems, and in most instances, is thought to be transmitted via blood. Typical manifestations of infection include narrowing of the intervertebral disc by erosion and bone destruction of adjacent vertebrae. Atypical spinal tuberculosis is a specific type of spinal tuberculosis. It mainly consists of single vertebral lesions, single posterior structure lesions, multiple vertebral lesions, and intra-spinal lesions. Skipped multifocal spinal tuberculosis is one of these types and is characterized by two or more vertebral lesions without the involvement of the adjoining intervertebral discs, regardless of their location. To date, only a few cases have been reported. Upon clinical admission, it can be treated conservatively or surgically, depending on the patient's symptoms. In addition, gene or biological therapies are being investigated. However, because of the exceptional imaging findings and insidious symptoms, it is often misdiagnosed as a neoplastic lesion, osteoporotic fracture, or other infectious spondylitis, increasing the risk of neurological deficit and kyphotic deformity, and delaying the optimal treatment window. In this study, we review the diagnosis and treatment strategies for skipped multifocal spinal tuberculosis lesions and enumerate the common differential diagnoses, to provide reference and guidance for clinical treatment and diagnosis direction.

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Section: Laboratory Examinationmentioning

confidence: 99%

Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions

Lyu

Zhang

2023

Orthopaedic Surgery

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“…So distinguishing spinal metastasis from spinal TB is essential to reduce pain, prevent neurological disability, minimize spinal deformity, and improve prognosis [5,6]. However, spinal metastasis and spinal TB show similar clinical manifestations and imaging features such as back pain, weakness, weight loss, vertebrae destruction, patholog-ical fracture, kyphosis deformity, and even neurological dysfunction [7], so it is difficult to distinguish the two accurately, especially in the outpatient department because of the limited consultation time and examination condition [8]. Although biopsy has been proved as the gold standard to distinguish spinal metastasis from spinal TB [9], it cannot be conducted in the outpatient department, so in actual outpatient work, the diagnosis was mainly dependent on the combination of clinical findings and auxiliary examination [3,10].…”

Section: Introductionmentioning

confidence: 99%

A Scoring System for Outpatient Orthopedist to Preliminarily Distinguish Spinal Metastasis from Spinal Tuberculosis: A Retrospective Analysis of 141 Patients

She

et al. 2021

Disease Markers

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Objective. Spinal tuberculosis (TB) misdiagnosed of spinal metastasis was not rarely reported, especially in outpatients department. This study was aimed to establish an outpatient scoring system to preliminarily distinguish spinal metastasis from spinal TB. Methods. We retrospectively reviewed consecutive 141 patients with a pathological diagnosis of spinal metastasis (82 cases) or spinal TB (59 cases) in our hospital from January 2017 to June 2018. The following clinical characteristics which can be obtained by outpatient orthopedist were recorded and analyzed: age, gender, malignant tumor history, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and imaging features including distribution characteristics of vertebral lesions, subligamentous spread, paravertebral or psoas abscess, involved vertebral element, intervertebral disc, and sequestra formation. The prevalence of clinical characteristics in spinal metastasis was evaluated, and the scoring system was established using logistic regression analysis. The performance of the scoring system was also prospectively validated. Results. The outpatient scoring system was based on five clinical characteristics confirmed as significant predictors of spinal metastasis, namely, malignant tumor history, subligamentous spread, posterior element lesions, preserved discs, and no sequestra formation. Spinal metastasis showed a significant higher score than spinal TB (8.17 points vs. 1.97 points, t = 18.621 , P < 0.001 ), and the optimal cut-off value for the scoring system was 5 points. The sensitivity and specificity of the scoring system for predicting spinal metastasis were 97.85% and 88.33%, respectively, in the validation set. Conclusion. Spinal lesions with the score of 5 to 10 would be considered a diagnosis of spinal metastasis, while the score of 0 to 4 may be spinal TB. Because the scoring system is mainly based on the clinical characteristics that can be obtained by an outpatient orthopedist, it is suitable to be used as a diagnostic tool in the outpatient department.

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Isoniazid

2015

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Atypical mycobacterial spondylitis as a challenging differential diagnosis to metastatic disease of the spine: a case report

Cited by 5 publications

References 23 publications

Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions

Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions

A Scoring System for Outpatient Orthopedist to Preliminarily Distinguish Spinal Metastasis from Spinal Tuberculosis: A Retrospective Analysis of 141 Patients

Isoniazid

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